by Rebecca Cook
Vanderbilt School of Medicine
I've spent my first 2 weeks at Kijabe Hospital working on the internal medicine team of the men's ward. Inpatient medicine at a tertiary care hospital is a quite a change of pace from rural primary care at Lwala. We have more diagnostic and treatment abilities, but also "sicker" patients. The variety in what I've seen has been tremendous – everything from the "bread and butter" medicine cases I see in the US like COPD, CHF, and diabetes but also lots of infectious diseases (HIV/AIDS, TB infections in every manifestation (brain, lung, abdomen), meningitis). I've taken care of men as old as late 80s and as young as 15 (the cut-off for pediatrics here is 12). I work on a team with a medical officer intern (equivalent of an intern in the US), a clinical officer (equivalent of a nurse practicioner/physician's assistant), along with two family practitioners that come on attending rounds with us once a day and are there for "back-up" if we need it. Besides my amazing patients, my favorite thing about Kijabe is the people I work with. The medical intern and clinical officer on my team are really bright, hardworking, and compassionate Kenyan women; they have tons of experience, especially with physical diagnosis skills and they're a pleasure to work with. The hospital always seems to be at or above capacity, basically our 80-bed men's ward almost always has beds in the hallway. The wards are fairly public with 10 beds in a room. The advantage is that many times when I get stuck with language I have a built in interpreter in the bed next door, or if I'm trying to gauge the progress of one of my patients a brain infection and altered mental status, his neighbors will chime in and tell me how he's doing. They often times really look out for each other. Yet this "built-in" community does also bring the challenge of maintaining confidentiality and privacy for patients; for example when a patient is newly diagnosed with HIV, they often have not yet decided to disclose their infection to their family, much less the stranger in the bed next door.
A few firsts for me this month:
-Being the one to share with a previously healthy 51-year old police officer that he has advanced cancer, follow him and his wife through 10-days in the hospital while stabilizing him from acute kidney failure only to have him pass away while traveling to the national hospital for chemotherapy
-Performing my first lumbar puncture (and second, and third)
-Seeing my first case of rheumatoid lung, TB pericarditis, HIV cardiomyopathy, cryptococcal meningitis, thyrotoxicosis, among others....
Sometimes the limitations in terms of nursing staff, diagnostics, or therapies are frustrating. At the same time, I'm amazed by how much can be done, and how often patients and their families fill the gap in care. Once a week all of the hospital staff gather for a chapel service and I've found this time to be important. It's a time when titles don't matter, when the lab tech and a nursing student may be leading the singing, and we're all just there to renew strength and hope when we reach our own limits.